How Insurance Works.

Medicaid is a health care coverage program jointly administered by the federal and state governments. It assists low-income individuals in specific groups with medical care and prescription costs. Unlike standard insurance programs with monthly payments and deductibles, Medicaid directly compensates providers for beneficiaries’ care. In addition to low-income individuals, Medicaid covers several other groups, although some qualifications may change due to upcoming healthcare reforms.

Medicaid covers the following groups:

• Pregnant women
• Women with children under 6
• Children aged 6-19
• Supplemental Security Income recipients
• Young adults up to 21 living alone
• Individuals over 65
• Those who are blind or deaf
• Many states also offer coverage for the “medically needy,” enabling individuals who do not fall under the above categories but require medical treatment and have an income below the Federal Poverty Level to receive Medicaid.

Individuals with mental illnesses may qualify for Medicaid if deemed disabled, either as children or adults after turning 19. Adults determined to be disabled receive Supplemental Security Income (SSI) from the Social Security Administration, which provides modest monthly financial support. To check SSI eligibility, visit http://www.ssa.gov/ssi/text-eligibility-ussi.htm.

Children may be eligible for Medicaid through their State’s Children’s Health Insurance Program (SCHIP), which often has more lenient requirements.

To apply for Medicaid, ensure you meet the income and eligibility requirements and contact your state office for specific inquiries about eligibility.

Medicare is a federally run health coverage program that operates more like traditional health insurance than Medicaid. It is not income-based but focuses on age or disability status. To enroll in Medicare, individuals must have received Social Security disability benefits (SSDI) for at least two years.

Medicare resembles private insurance with deductibles and co-pays and comprises four parts, each offering different coverage:

Part A: Covers hospitalization and inpatient services.

Part B: Covers outpatient services and routine medical care.

Part C (Medicare Advantage): Extends benefits of Parts A, B, and D.

Part D: Covers prescription drugs. Those with low incomes receive additional assistance with prescription costs and deductibles.

Individuals under 26 can be covered under their parents’ insurance plan due to healthcare reform law changes.

Employer-provided health insurance as part of a benefit package.

Continuing health insurance coverage after job loss by paying premiums.

State universities may offer healthcare plans for undergraduate students, while large schools and universities may have their own clinics or teaching hospitals. Some institutions offer programs for graduate students.

For those ineligible for other insurance options, purchasing private insurance is a possibility, although it can be expensive and requires careful evaluation of the plan.